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recruiting your own nurses for home care

Anyone recruit your own nurses without an agency? I have a good core group of nurses but am forced to deal with a handful of nurses that really suck. The problem is insurance, scheduling and payment. Is there an alternative entity to agencies that deal with these aspects of nurse management?

Do you really need a nurse, or would a personal care attendant be more along the line of your needs? Are you private paying the agency now? We hired PCAs for my mother...some were home health aides (HHA) or certified nursing assistants (CNAs), some were in nursing school working toward their RN, and a few had no medical training but had worked as family caregivers, etc. I did all the recruiting, and found a lot of good people through Craig's List. We always trained them ourselves, and interviewed and checked references based more on willingness to do the work, be on time, and be reliable and honest. We paid cash (direct deposit to bank) but some use a book-keeper, esp. if they are withholding taxes and paying for any benefits. We did not pay any benefits; and looked for people part time who already had another job or health insurance coverage through a spouse, etc. I organized the schedule and hired specific to set schedules that we had set up.

We have had a lot of discussions on this forum about this issue...suggest you read some older threads.

I need 24 hour care because I have a trach. I have been reading other threads in this forum, particularly your posts on hiring your own caregivers for your mom. I've just read the difference between agencies, registries and doing all the work yourself. It seems that agencies are the easiest because they deal with taxes, payroll, insurance, scheduling and fill ins when people call in sick. For the short term, I just put an ad in craigslist (something you've suggested in other threads). For the long term, I'm looking at other agencies.

Will your worker's comp allow you to hire your own vs. going through an agency? This varies with the carrier. I think you are going to have a hard time finding licensed nurses (RNs) who are working outside of an agency in homecare who actually have a valid license and are not under some sanction (disciplinary action) from their licensing board. I know a number of people with trachs who hire PCAs rather than licensed nurses, but doubtful your WC would allow this.

I definitely am looking to hire RNs and I see it is better to stick with an agency. My objective is to find a couple of nurses that can work well with me and have them employed through the agency. I've found the agency just throws anyone in and if they are spending a considerable amount of time with me during the week, I should vet them out from the get go and get a feel of their personalty/work habits. Thanks for your input!

Do you really need a nurse, or would a personal care attendant be more along the line of your needs? Are you private paying the agency now? We hired PCAs for my mother...some were home health aides (HHA) or certified nursing assistants (CNAs), some were in nursing school working toward their RN, and a few had no medical training but had worked as family caregivers, etc. I did all the recruiting, and found a lot of good people through Craig's List. We always trained them ourselves, and interviewed and checked references based more on willingness to do the work, be on time, and be reliable and honest. We paid cash (direct deposit to bank) but some use a book-keeper, esp. if they are withholding taxes and paying for any benefits. We did not pay any benefits; and looked for people part time who already had another job or health insurance coverage through a spouse, etc. I organized the schedule and hired specific to set schedules that we had set up.

We have had a lot of discussions on this forum about this issue...suggest you read some older threads.

(KLD)

I may need to upgrade to a PCA; I currently have a home health aide come once a week. Bathing is an issue. I'm working with my care team on this, so I'm not looking for help with how to choose the right individual. I'm looking for advice and support about the transition from less to more care, especially how to maintain independence. It feels like a step toward more and more care, but I don't want that. I want to maintain my independence as long as possible. I will start a new thread if that would be more helpful. I have tried searching for threads related to this, but I'm not finding them. Can you please lead me in the right direction? Thank you.

So I think of it as a trade off. The (seriously abbreviated) backstory is that because of rapid changes due to medical complications etc., my need for care has fluctuated all over the place - I've gone from complete independence to being inpatient at a SNF to home with nurses for IV but otherwise independent to inpatient to home with PCAs for getting in and out of bed and bathing and a lot of other random levels of care in between.

Anyway, trade-off. The thing is, at least for me and maybe because I am older and have all this other medical stuff, my level of energy is not so predictable. I have to pick and choose. I'm trying to build stamina and so forth, which means that I expect to end my days physically tired. The trick is not spending the next day weeping with exhaustion. I can fold and put away all 3 loads of laundry, or I can make myself a weeks worth of lunch salads - just now, I can't do both, not on a day when I do my bowel program, dress myself, have therapy, water the yard, etc. In order to not become insane, I have to get outside, do as much of my personal care myself as possible and make some kind of push towards getting stronger. I trade off doing that stuff for more kind of housekeeping stuff. I expect my level of energy and native resourcefulness to ebb and flow, so I trade off. If getting help getting into the shower means I have more energy for washing myself and I can go into the office, I will solicit a push. That trade off works for me.

So I think of it as a trade off. The (seriously abbreviated) backstory is that because of rapid changes due to medical complications etc., my need for care has fluctuated all over the place - I've gone from complete independence to being inpatient at a SNF to home with nurses for IV but otherwise independent to inpatient to home with PCAs for getting in and out of bed and bathing and a lot of other random levels of care in between.

Anyway, trade-off. The thing is, at least for me and maybe because I am older and have all this other medical stuff, my level of energy is not so predictable. I have to pick and choose. I'm trying to build stamina and so forth, which means that I expect to end my days physically tired. The trick is not spending the next day weeping with exhaustion. I can fold and put away all 3 loads of laundry, or I can make myself a weeks worth of lunch salads - just now, I can't do both, not on a day when I do my bowel program, dress myself, have therapy, water the yard, etc. In order to not become insane, I have to get outside, do as much of my personal care myself as possible and make some kind of push towards getting stronger. I trade off doing that stuff for more kind of housekeeping stuff. I expect my level of energy and native resourcefulness to ebb and flow, so I trade off. If getting help getting into the shower means I have more energy for washing myself and I can go into the office, I will solicit a push. That trade off works for me.

Thank you. I appreciate you sharing your perspective. I'm in a similar boat when it comes to ADL's; if I do laundry, I don't have the energy to bathe. It helps to be reminded that getting more help doesn't mean it's all downhill. In fact, it may make me able to do more!

I'm just going to make sure my team understands I want to stay independent. My goals should include making accommodations where possible to allow more independence. Someone said something to me recently about being careful what I say, because I don't want the team to suggest I need a higher level of care to maintain safety...I'm probably over thinking it. I do that. 😜